6282-14-1 Folio 39

Name: Bernard SHAW,

Aged: 65,

Reg. No. 39,

Admitted: August 16, 1899.

Copy of Statement of Particulars

Reception Order signed by: Arthur Serena, Dated: May 24, 1898

Sex and Age: m 64

Civil State: Married

Occupation: Baker

Religion: Wesleyan

First Attack: Yes

Age on first attack: 64

When and where previously under treatment: Claybury Asylum (Crossed out)

Duration of present attack: 3 months

Supposed cause: Religious Worry

Epileptic: No

Suicidal: No

Dangerous to others and how: No

Any near relative afflicted with Insanity: No

Union chargeable to: St. Marylebone

Previous Place of Abode: St. Marylebone Workhouse

Name and Address of Person to whom Notice of Death to be sent: Wife (as below)

Names and Addresses of one or more relatives of the Patient: Mary Shaw, 15 Charbert St., N.W.

Medical Certificate

Medical Certificate Signed by: Agiline

Facts indicating insanity observed by myself at the time of examination viz.:

He informed me that the Holy Ghost is inside him & that small birds are continually hovering around him telling him to do this & do that.

Facts communicated by others viz.:

Wm. G. Lowden (Attendant) Marylebone Workhouse tells me that the patient tells him that a bird comes & tells him all manner of things & also that he had seen the Holy Ghost inside him, i.e. George Snowden.

Transferred from: Claybury

Condition on Admission

Mental State:-

As far as possible under such Headings as:
Attention, Comprehension and Re-action, Cognition of self and surroundings, including mistakes of identity and appreciation of time and place, States of Stupor and Catalepsy, Memory for recent and remote events, Association and flow of ideas, Coherence, Reasoning power, Hallucinations, Illusions, Delusions, Exaltation, Fantasies of dress, Excitement, Depression, Impulses—General, Suicidal, Homicidal, Erotic, Destructive, Obsessions, Resistiveness or Hostility, Restlessness, Self-employment, Attention to personal needs, Religiosity, Sense of propriety, Lewdness of conversation and conduct, Regard for relatives.

Says he becomes very depressed at times & feels wild. He was drugged by a fellow workman through jealousy. And then a man was also drugged & he too was taken to an asylum. He is going to make further enquiries into this when he gets out.